Residency duty-hour limits have no effect on patient safety

Limits to the number of hours residents can work in a shift have made no difference in patient safety outcomes, according to research published in the Journal of Hospital Medicine.

The researchers, led by Lauren Block, M.D., analyzed outcomes data from general medicine patients at a large academic medical center from July 2008 to June 2012. Block and her team looked at several outcome measures, including length of stay, presence of hospital-acquired conditions, inpatient mortality, 30-day readmission rates and intensive care unit (ICU) admissions, according to the study abstract.

A 2011 residency work-hour mandate limited first-year residents to shifts of no longer than 16 hours. Since the reform's implementation, patients discharged from resident services are more likely to be admitted to the ICU, according to the study, but they are at lower risk of readmission within 30 days.

There were no major differences in patient safety outcomes pre- and post-reform, according to the researchers. "Further study of the long-term impact of residency work-hour reforms is indicated to ensure improvement in patient safety," the researchers wrote.

A study last year published in JAMA Surgery found the duty-hour restrictions correlated with a 25.8 percent drop in operating case load, with the decrease reaching 31.8 percent for major cases and 46.3 percent for first assistant cases, FierceHealthcare previously reported. Under the mandate, first-year residents "are simply not finding enough time to practice," Samer Mattar, M.D., said. "You can't go to a pilot and tell them they can't use a flight simulator because it's time to go home."

"The 16-hour work limit for interns, implemented in July 2011, is associated with a significant decrease in categorical intern operative experience," the JAMA Surgery study's authors wrote. "If the 16-hour shift were to be extended to all postgraduate year levels, one can anticipate that additional years of training will be needed to maintain the same operative volume."